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Film seeks to rewire thinking on drug abuse

I grew up in an era of magical thinking, when the solution to poverty lay in the mystical machinations of trickle-down economics, and "Just say no" was the strategy for both drug addiction and abstinence-only sex education.

The tendency of wishful policy-making to frustrate its own goals -- more poverty, drug use and teenaged pregnancy -- has helped drive a shift toward evidence-based policy. But enduring stigma around addiction, long perceived as a character weakness, has meant a slow, upward climb.

Years of evidence supports harm-reduction strategies for drug users. Needle exchange programs reduce the spread of HIV and other blood-borne infections. Supervised injection sites reduce overdose deaths. But many remain uncomfortable "condoning" drug use, just as some feel educating teens about condoms is promoting sex.

Harm reduction, according to the Centre for Addiction and Mental Health, describes programs "designed to reduce drug-related harm without requiring the cessation of drug use."

Legislators apply the same principle when they regulate smoking in public spaces to decrease harm from second-hand smoke, rather than a futile effort to confiscate all the cigarettes.

Filmmaker Hugh Gibson is seeking to change the way people view harm reduction with his documentary The Stairs. Over a five-year period, the film follows the lives of three social workers at the Regent Park Community Health Centre in Toronto. They speak frankly about their own addiction struggles and help distribute clean pipes and condoms without judgment.

The Toronto Film Critics Association recently awarded The Stairs Best Canadian Film of 2016. Not best documentary -- best feature film. The characters' stories are compelling and often surprising. One reason the film is so effective lies in what it lacks. There are no talking heads or "expert" panels pontificating on harm reduction. The experts are the people living through addiction and bravely sharing their stories.

"Disclosing is second nature," says Roxanne, a sex worker who returned to school at 47. As a social worker, she says, sharing her experiences helps build trust and encourages clients to open up. Her T-shirt reads: Keep Calm and Carry Naloxone.

Naloxone is an increasingly essential tool in the harm-reduction toolkit. It can reverse an overdose in minutes. In the midst of Canada's opioid epidemic, cities are struggling to equip first responders with enough. The demand is so great last July, Health Canada temporarily approved the sale of a nasal spray version of the drug while still under expedited review; it is approved by the U.S. Food and Drug Administration.

In addition to distributing the opioid antagonist to paramedics and firefighters, some outreach programs seek to put Naloxone directly in the hands of people who use opioids or have a history of drug use. Opioids can depress respiratory function until users simply stop breathing, or "nod out." The greatest risk comes from using alone.

England and Germany paved the way for distributing Naloxone kits to opioid users in 1995. Ten years later Edmonton established the first Canadian outreach program. Toronto Public Health began distributing Naloxone kits to current and past opioid users and their families in 2011. It's an intramuscular injection, so training is minimal. Nasal spray is even easier to administer.

After five years documenting harm reduction in Regent Park, Gibson remains struck by how little it is known and understood. He hopes his film can contribute to a changing conversation about drug use and street involvement. "I want it to humanize things that have been dehumanized. I hope people will look at a subject that's had a lot of discrimination and, I hope, see it in a new light."